When COVID-19 hit, Mariana Lenharo, a freelance science and health journalist, found herself cooped up in her native Brazil. While the pandemic impacted everyone in the country, Lenharo’s mind drifted to the children who were born during the Zika epidemic of 2016, and she wondered how those children—who needed intense care and therapy—were faring during the pandemic. To her surprise, Lenharo learned that many of the families who had participated in Zika studies now felt abandoned by those scientists, whom they accused of getting caught up in COVID-19 and failing to share their results. Feeling forgotten, some families said they were now reluctant to take part in research going forward.
Lenharo’s discovery prompted her to write a story for Undark in 2021, in which she explored tough questions about what the research community owes to patients, not just during a health emergency, but also after it’s over—an ethical dilemma that looms large everywhere in an age of global outbreaks.
Zika, COVID-19, Ebola, and monkeypox all began as local problems before they mushroomed into international ones, harming and killing people across borders. But it can be difficult to find and sell stories about those diseases to U.S. or international publications whose primary audience hasn’t come into contact with them—yet. “Our media ecosystem, because it is concentrated in certain parts of the world, only really starts paying attention to some topics when they’re affecting people in those parts of the world. And I don’t think that’s necessarily smart coverage,” says Brooke Borel, an articles editor at Undark who edited Lenharo’s story.
Some of the challenges of selling and publishing stories about global disease outbreaks are outside individual reporters’ control. Still, if you’re willing to work to develop the right sources and think creatively about the angles from which you report out your stories, while being mindful about the nuances and sensitivities that come with reporting on global diseases, you can find stories that will be informative, thought-provoking, and engaging to readers no matter where they live, and even if they’re never affected directly by those issues. Amy Maxmen, a former Nature reporter (now an Edward R. Murrow Press Fellow at the Council on Foreign Relations) who specializes in covering global health and life sciences, says, “Journalists should really push hard to care about people everywhere, both because of biosecurity, but also because it’s the ethical thing to do.”
To Find Stories, Go to the Source
Given the multitude of infectious disease outbreaks unfolding at the same time, homing in on story ideas and deciding which ones to cover can be daunting. You can begin your search in scientific journals like The New England Journal of Medicine and BMJ Global Health, which routinely publish about global health issues of all kinds. It’s also worthwhile to read journals that cover a specific subset of diseases, like the Malaria Journal or PLOS Neglected Tropical Diseases. For example, Maxmen got the idea for her 2018 Nature story about a rise in drug-resistant malaria in Southeast Asia when an increasing number of research papers hinted at the spread of resistance in that region.
Nongovernmental organizations, think tanks, and aid groups also publish white papers and reports about problems in the field, and these are brimming with potential stories. One such think tank, Policy Cures Research, publishes an annual report analyzing global research-and-development investments in fighting emerging infectious diseases.
Apart from policy reports, numerous worldwide disease-surveillance networks made up of researchers, health officials, and other experts keep track of emerging infectious diseases in real time. The Program for Monitoring Emerging Diseases (ProMED), operated by the International Society for Infectious Diseases, is one such network. It runs an email listserv that collates discussions about outbreaks happening around the world, and reporters can subscribe to get updates about certain diseases or places. On December 30, 2019, a ProMED post about unexplained pneumonia in China caught the eye of STAT infectious diseases reporter Helen Branswell, who then tweeted about having “SARS flashbacks.” Days later, she was the first U.S. journalist to write a detailed report about a potential new coronavirus outbreak.
Above all else, it is important to keep an ear to the ground and communicate with local sources as much as possible, including community organizers, doctors, nurses, and other medical professionals working in the region.
Although many stories about global health tend to focus on the particulars of a disease, from how it’s affecting populations to the public health response it inspires, other stories cover the institutions that make up the enterprise of global health: government agencies, companies, nongovernment organizations, and philanthropies. Journalists can hold them accountable for their pledges and explain how their policies are being implemented. One resource for this line of reporting is Devex, an online news publication that caters to researchers, health-care workers, and practitioners in the global health and international development space. It runs a database of funding announcements, making it a good place to track trends in funding for a particular disease or from a particular donor. “There are obviously a lot of stories that you can do from the ground,” says Amruta Byatnal, a New Delhi–based senior editor at Devex who focuses on global health coverage, but “what is missing, really, is this middle layer of how things get done.” For example, Devex’s former senior reporter Lisa Cornish* used the database, along with other sources, to track global COVID-19 funding for the first six months of 2020, identifying where the funds were coming from, who the money was going to, and what the funding was focusing on.
Above all else, it is important to keep an ear to the ground and communicate with local sources as much as possible, including community organizers, doctors, nurses, and other medical professionals working in the region. When reporting remotely, Maxmen first peruses PubMed for papers written by local scientists, who may be able to both talk to her and help her connect with other colleagues in the field or with patient groups.
Directly contacting health organizations or nongovernmental organizations in the area is also a good way to find sources. “You have these people all across the world who are basically doing the public health work there, who live in that context, who breathe that context, and who can tell you about that context, if you’re willing to listen and if you give them a chance to speak,” says Kai Kupferschmidt, a contributing correspondent for Science who specializes in infectious disease coverage and is based in Berlin.
When Kupferschmidt began covering the 2014 Ebola outbreak in West Africa, he wondered if that outbreak was more severe than previous ones because the virus had mutated or had become more virulent in some way. But as he started speaking with local experts while reporting from Liberia, one of the worst-hit countries, it became apparent that social and political upheaval was what was allowing the virus to flourish. “Two civil wars, lack of trust in the government, very porous borders, recent changes in the connectivity in that place—all of these things together, plus urbanization, climate change, destruction of environment, created an opportunity for this virus to spread in a way it hadn’t before,” says Kupferschmidt.
This experience was a sobering reminder about the importance of understanding “how a pathogen interacts with human culture” while covering an outbreak, says Kupferschmidt, and underscores the necessity of deep background research into a place’s social customs, politics, and history. Similarly, Maxmen says that before a major reporting trip, she looks up news articles about the country’s political situation and reads through several feature stories—and not necessarily about the disease she’s reporting on—that have been written in the past 30 to 40 years. Nonfiction books on anthropology or political history are another resource she uses to understand the social and political context of a place before reporting there.
While a great deal of research can be done by phone and email, the stories that emerge from in-person reporting are often counterintuitive, more nuanced, and more fascinating than expected. Maxmen, who has reported from several different countries in Africa and Asia, emphasizes the importance of talking to people on the ground in addition to nonlocal experts. When reporting her story about COVID-19 vaccine inequity, Maxmen says, a lot of experts in the West she spoke with attributed low vaccine uptake in low-income countries to misinformation regarding the vaccines. But while reporting in Malawi in southeastern Africa and speaking with locals and nurses in those communities, she learned that there weren’t a lot of vaccines to begin with and that residents, especially in rural areas, often did not know where to get the vaccines even if they were available, and sometimes had to walk for more than an hour to reach health clinics.
“The lack of supply, distribution, and healthcare was the key blockade,” Maxmen said in an email, and not misinformation. Such disparities between what’s happening on the ground and what experts in the West think is happening has come up “time and time again” in Maxmen’s reporting, she says.
To Sell Stories, Find the Bigger Angle
To convince editors of the importance of stories about global diseases, especially ones in geographically faraway places, think creatively about how you frame your stories. It may seem straightforward to report that an outbreak is happening and to explain why it’s happening. But the simple fact that something is happening does not necessarily clear a news outlet’s bar for assigning a story.
Another way to bring big, complex issues to life is to highlight individuals at the center of a story, whether they are patients or researchers.
Instead, you might ask: What lessons do an outbreak, or a country’s response to an outbreak, have to teach the rest of the world? “It could be something that’s gone totally wrong; it could be something that went really right; it could be some public health system that actually responded to something,” says Borel. In 2019, health journalist Apoorva Mandavilli wrote for Undark about a measles outbreak in a small clinic in Massachusetts, recounting the staff’s high-stakes, painstaking efforts to contact-trace hundreds of people and immunize anyone who wasn’t vaccinated. While the story was about one small outbreak, Mandavilli (now a reporter at The New York Times) used it to illuminate larger public health lessons, from the importance of training nurses and volunteers to having updated immunization records of all staff members so they could be part of the response team.
Another way to bring big, complex issues to life is to highlight individuals at the center of a story, whether they are patients or researchers. “We’re making sure that real human beings are included in an article, how they are affected, how researchers are motivated, and why they are so committed to addressing this particular disease,” says Brian Simpson, the editor-in-chief of Global Health NOW, a reporting initiative from the Johns Hopkins Bloomberg School of Public Health.
For example, Simpson points to a story about how the COVID-19 pandemic had afflicted leprosy patients in India, in which Kamala Thiagarajan, a freelance journalist based in Madurai, India, profiled a 67-year-old woman whose post-leprosy care was thwarted by pandemic-induced lockdowns. Using her story, Thiagarajan explained the pandemic’s impact on routine leprosy screening and on the production of specialized footwear that leprosy survivors need, among several other disruptions caused by COVID-19.
In Telling Stories, Avoid Perpetuating Stereotypes and Stigmatizing People
Reporting on global health, and particularly on infectious disease outbreaks, can raise thorny ethical dilemmas. As with all stories in which journalists are reporting on foreign-to-them places, covering global disease outbreaks responsibly requires anticipating ethical and logistical challenges, being mindful of the power dynamics with the communities they report on, and collaborating with local journalists and fixers. (Shi En Kim delves into how to handle these issues in extensive detail in her guide on how to report on international stories ethically.) It’s critical for reporters to be wary of their own biases and assumptions, and to avoid stigmatizing or scapegoating people who have contracted an illness, especially when the illness is spreading within a geographic region or in communities that are historically undercovered by the mainstream media.
You should carefully choose your words, both when interviewing people and describing them in stories.
That includes avoiding illustrating stories with images that unintentionally reinforce racial stereotypes. “Because most monkeypox cases prior to [the current] outbreak were in Central and West Africa, many of the images initially available were of people of color,” NLGJA: The Association of LGBTQ Journalists notes. Instead, the group advises that “as that does not reflect the reality of this outbreak, which is affecting people of all races, images of the current outbreak should include pictures of people from a variety of backgrounds and racial/ethnic groups.” A similar phenomenon occurred in the early days of COVID-19 coverage. As the Asian American Journalists Association has observed, news outlets sometimes ran pictures of mask-wearing people in East Asian countries without making clear that masks were widely used in those regions for years before the coronavirus hit.
You should also carefully choose your words, both when interviewing people and describing them in stories. In the case of the coronavirus pandemic, the World Health Organization recommends using neutral language instead of language that assigns blame to individuals for transmitting the disease (“people who may have COVID-19” rather than “COVID-19 suspects”). Even seemingly minor word choices can make a difference, Kupferschmidt notes. Consider, for example, the characterization of monkeypox as “spreading among gay men” rather than “being spread by gay men”: The former makes the virus the villain, whereas the latter blames the infected people.
In its guidance on covering monkeypox, NLGJA: The Association of LGBTQ Journalists advises journalists to consider their audience when deciding on terminology. Saying that the virus “is currently spreading among men who have sex with men” is accurate and emphasizes that it’s the behavior that drives risk, and not a sexual orientation, and may be appropriate language to use in stories focused on the clinical aspects of the outbreak. However, the organization notes, for stories that are focused on the virus’ effects on LGBTQ communities, it may be more appropriate to use other terms for describing those most at risk. Possible descriptors include “men who have sex with men and their sexual networks” and “men who have sex with men, a group that includes people who identify as gay, bisexual, transgender, and nonbinary.”
In addition, although certain communities may be at heightened risk for a given infection, make clear that those communities aren’t the only ones at risk. “The most important principle to keep in mind is to always be direct and factual in terms of transmitting the information and really rely on the facts … [while] also reminding people that the virus doesn’t discriminate and everybody is potentially susceptible,” says Wafaa El-Sadr, a professor of epidemiology and medicine at Columbia University’s Mailman School of Public Health.
One way to help ensure that you are reporting fairly is to seek out sources who have expertise in the form of lived experience, in addition to “official” experts like scientists and clinicians. When in doubt, a publication can employ sensitivity readers to provide feedback on language and flag unconscious biases.
Ultimately, when reporting on global health, “you always end up with the question of why do we live in a world where there are so many inequities and how do we deal with them?” says Kupferschmidt. In an interconnected world, these questions are of concern to everyone, and it’s the job of journalists to show others why they should care. As Borel puts it, “We are all on one planet and we’re all sharing the same resources and same air.”
*Correction 10/4/22: An earlier version of this story misspelled Lisa Cornish’s name.
Pratik Pawar is an independent science journalist who writes about global health, ecology, and science policy. A TON early-career fellow supported by the Burroughs Wellcome Fund, he lives in Bangalore, India. Pratik’s work has appeared in Discover, Science News, The Wire, and Undark, among other publications. Follow him on Twitter @pratikmpawar.